ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, January 28, 1996 TAG: 9601260113
SECTION: EDITORIAL PAGE: F-3 EDITION: METRO
SOURCE: PERCY WOOTTON, M.D.
IMAGINE Virginia with no resource to educate its future doctors, nurses and medical researchers. Imagine the commonwealth with no hospital facility to care for adults and children who cannot afford to pay for medical care. Imagine the health-care marketplace in Virginia without its two teaching hospitals, which employ approximately 9,000 people in Richmond and Charlottesville.
We may not have to leave those scenarios to our imaginations if the state's two teaching hospitals - Virginia Commonwealth University's Medical College of Virginia Hospitals and the University of Virginia Medical Center - stay on their present tracks, tied to state regulations.
VCU is asking the General Assembly to form a separate governmental public authority - or quasi-private entity - for its teaching hospital, a plan that will help the academic medical center survive by giving it flexibility in personnel issues, capital planning, and outlay and purchasing matters, making it stronger financially. This is not a request for separation from the state; MCV Hospitals has no interest in that. Under the public-authority model, MCV Hospitals will still be a part of the legislative process.
The academic medical centers and undergraduate medical education in Virginia are at serious risk. To better understand the need for the VCU's hospital to become an authority, consider:
nOnly about 29 percent of VCU's medical school budget is derived from state funds. In 1993-94, VCU ranked 66th out of 74 public medical schools in the country in terms of state support per medical student.
nIt costs about $70,000 a year to educate medical students at VCU/MCV. Clinical practice and hospital revenues for health services are the major source of this funding. In fact, these revenues provide more than half the medical school's budget. If MCV Hospitals cannot effectively compete in the managed-care market, hospital and clinic revenues will rapidly decrease, and that will mean increasingly less support for undergraduate medical education.
nWith increased competition, declining federal funding of Medicare and Medicaid, and reduced payments from insurance companies, MCV Hospitals and its physicians project a decrease in clinical revenue over the next five years, which translates into less funding for the education of medical students.
nMCV Hospitals and MCV Associated Physicians provide 35 percent of Virginia's indigent care, which includes more than $30 million of unreimbursed care each year - a loss neither the hospital nor the practice plan recovers.
The authority model is a self-help method of survival. It will allow the hospitals to respond to managed-care challenges and remain viable in the health-care marketplace. The authority model will allow VCU to become more efficient and competitive, maintain revenue, continue to provide supoort for medical education and enhance our ability to be as self-supportive as possible. The university does not expect the General Assembly to open the door to increased and limitless funding for MCV Hospitals. Proposing an authority model is a major piece of VCU's plan to help itself financially and a means of fulfilling its mission to maintain revenue and continue to support medical education.
Increasing MCV Hospital's competitive posture will enhance the likelihood of achieving needed partnershps with its counterparts in the health-care delivery business - something that is very difficult now. The government authority also would benefit hospital employees. Under the authority model, there would be far greater likelihood of higher earnings and of increased job security.
I, along with physicians across Virginia, can testify to the sound medical education one receives at VCU and UVa. Our two teaching hospitals have provided medical education and services to Virginians for nearly 200 years. The creation of public authorities for each of our hospitals would greatly improve our ability to compete effectively in the health-care market.
To deny the hospitals this request would be a disservice to the best and the brightest Virginians awaiting to attend these nationally recognized institutions, and to all Virginians who stand to benefit from the care the doctors, nurses and researchers provide. Let's hope the Virginia legislature will look to the authority model to protect the foundations we have built.
Percy Wootton, M.D., a Richmond cardiologist, is a member of the Virginia Commonwealth University Board of Visitor and a past president of the Medical Society of Virginia.
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